Manometric appreciation of the anal sphincter function, when aiming for a "sphincter saving" procedure in patients with low rectal cancer

Abstract Objective: Sphincter saving techniques in low rectal cancer represents a challenge for the surgeons in their attempt to preserve the sphincter function and also to respect the principles of oncological surgery, in order to improve the quality of the patient’s life. The paper’s aim is to compare different sphincter saving techniques in regards to the early postoperative results. Methods: An observational, retrospective study was performed on 76 patients (N = 76) operated for low rectal cancer in the Surgical Clinic no.1 of the Targu Mures Emergency Clinical County Hospital, between January 2010 and October 2014, to whom the rectal resection was followed by a primary restorative technique for preservation of the sphincter function. The immediate postoperative results after different types of sphincter saving procedures were analyzed and compared. Results: From the studied patients, in 41 cases (53.94%) an anterior rectal resection with low colorectal anastomosis was done („very low” Dixon procedure), for 29 patients (38.15%) a sphincter saving technique with a peranal anastomosis was performed and in 6 cases (7.89%) an intersphinteric rectal resection with coloanal anastomosis was made. Conclusions: Sphincter saving techniques, if oncological principles are respected, represents a viable option in the treatment of low rectal cancer and brings hope for improving the quality of the patients’ life.

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Assessment of bowel and anal sphincter function after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Tumori Journal ◽

10.1177/0300891618765580 ◽

2018 ◽

Vol 104 (2) ◽

pp. 121-127 ◽

Cited By ~ 2

Author(s):

Consuelo Rosa ◽

Monica Di Tommaso ◽

Luciana Caravatta ◽

Annamaria Vinciguerra ◽

Antonietta Augurio ◽

...

Keyword(s):

Rectal Cancer ◽

Anal Sphincter ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Well Being ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Sphincter Function ◽

Anal Sphincter Function ◽

Increased Risk

Purpose: To report long-term effects on anorectal function and bowel disorders and late toxicity rate of preoperative chemoradiotherapy in patients with locally advanced rectal cancer. Methods: Between 2000 and 2016, 201 patients treated with different neoadjuvant schedules of chemotherapy and radiotherapy doses were retrospectively analyzed. The Memorial Sloan–Kettering Cancer Center score was used for the evaluation of anal sphincter function. Results: The median follow-up time was 68 months (interquartile range 35–113 months). Radical resection was performed in 188 (93.5%) patients with a pathologic complete response rate of 26.4%. Overall sphincter function resulted excellent in 105 (52.2%) patients, good in 13 (6.5%), fair in 10 (5.0%), and poor (incontinence) in 40 (19.9%), with a persistent stoma rate of 16.4%. A further evaluation on 194 patients showed an improvement of sphincter function after 2 years in 11.9% of them. Seventy-three patients presenting stoma or poor sphincter function were re-evaluated for quality of life (QoL) indexes. Twenty-one (29%), 19 (26%), and 24 (33%) of them declared some variations concerning well-being, fatigue, and ability to perform daily activities. The 5-year overall survival, disease-free survival, and local recurrence rates were 88.0% ± 2.6%, 86.3% ± 2.5%, and 94.6% ± 1.9%, respectively. Conclusions: In our study, neoadjuvant chemoradiotherapy was associated with good results in terms of sphincter function, late toxicities, and QoL indexes. A routine use of assessment scales could contribute to a better selection of patients with increased risk of developing functional disorders who could benefit from neoadjuvant therapy.

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